Tim UnderstandingHospitalProfessionalLiability WEB

2/11/14%
1%
2/11/14%
UNDERSTANDING+HEALTH+CARE+
PROVIDERS+PROFESSIONAL+
LIABILITY+COVERAGE+
Presented%by:%
Tim+Northrop,+Vice+President+Chief+Insurance+OperaEons+Ocer%
%
Preventable+Medical+Errors%
The%Ins3tute%of%Medicines%
(IOM)%seminal%study%of%
preventable%medical%errors%
es3mated%as%many%as%98,000%
people%die%every%year%at%a%
cost%of%$29%billion.%
Deaths/Mortality,+2005,+NaEonal+Center+for+Health+Care+StaEsEcs+at+the+Centers+for+Disease+Control,+
+viewed+at+hSp://www.cdc.gov/nchs/fastats/deaths.htm.%
2%
2/11/14%
Preventable+Medical+Errors%
Leading+Cause+of+Death+in+United+States+
1%
Heart%Disease%
652,091%
2%
Cancer%
559,312%
3%
Stroke%
143,579%
4%
Chronic%Lower%Respiratory%Disease%
130,933%
5%
Accidents%(uninten3onal%injuries)%
117,809%
6%
Diabetes%
%75,119%
7%
Alzheimers%Disease%
%71,599%
8%
Inuenza/Pneumonia%
%63,001%
9%
Nephri3s/Nephrosis%
%43,901%
Preventable+Medical+Errors+
10% Sep3cemia%
+98,000+
%34,136%
%Deaths/Mortality,%2005,%Na3onal%Center%for%Health%Care%Sta3s3cs%at%the%Centers%for%Disease%Control,%
Deaths/Mortality,+2005,+NaEonal+Center+for+Health+Care+StaEsEcs+at+the+Centers+for+Disease+Control,++viewed+at+hSp://www.cdc.gov/nchs/fastats/deaths.htm.+
%viewed%at%hPp://www.cdc.gov/nchs/fastats/deaths.htm.%
AdvenEst+Hospitals%
! PATIENT'S%FAMILY%ALLEGED%MEDICAL%NEGLIGENCE%DURING%SURGERY%bRupture%of%
appendix%b%medical%negligence%
! 51%YEAR%OLD%FEMALE%UNDERWENT%LAPOROSCOPIC%CHOLYCYSTECTOMY%AND%
IOTROGENIC%PERFORATION%TO%DUODENUM.%%INFECTION%TREATED%LATER%AS%WERE%
PULMONARY%COMPLICATIONS.%Claimant%alleged%medical%mistakes%for%her%
condi3on%
! COMPLAINTS%OF%DAMAGE%TO%LEFT%EYE%DURING%LASER%SURGERY.%SURGEON%IS%
INSURED%BY%ANOTHER%COMPANY.%
! PATIENT%FELL,%BUTTOCKS%FIRST,%INTO%A%TOILET%(BROKEN%SEAT%ALLEGED).%%
NURSING%ATTENDANT%EXTRACTED%HER%FROM%COMMODE%AND%BROKE%HER%
COLLARBONE.%
! 72%YEAR%OLD%LADY%WENT%BLIND%AFTER%BILATERAL%CATARACT%SURGERY.%%DOCTOR%
TOLD%HER%THAT%AFTER%THE%SURGERY%SHE%WOULD%BE%ABLE%TO%"THREAD%A%
NEEDLE".%%SHE%CAN'T.%
! ASTHMA%PATIENT%FELL%GETTING%OUT%OF%BED%TO%GO%TO%THE%BATHROOM.%%
BROKEN%ANKLE%LED%TO%DEEP%VEIN%THROMBOSIS.%
3%
2/11/14%
AdvenEst+Hospitals%
! 3%WEEK%PREMATURE%NEWBORN%WAS%GIVEN%MEDICATION%IN%A%MANNER%THAT%
MAY%HAVE%CAUSED%DEATH.%%WAITING%FOR%AUTOPSY%REPORT.%
! FALSE%POSITIVE%ON%HIV%BLOOD%TEST.%%24%HOURS%OF%ANXIETY%BEFORE%RETEST%
RESULTS%PROVED%NEGATIVE.%
! 45%YEAR%OLD%MOTHER%OF%FOUR%DIED%OF%CYST%AT%BASE%OF%HER%BRAIN%WHILE%
UNDERGOING%A%CT%SCAN.%%ALLEGATIONS%THAT%INJECTIONS%GIVEN%MADE%HER%
CONDITION%DETERIORATE%AND%CAUSED%HER%DEATH.%
! INFECTION%POST%LASER%SURGERY%ON%EYES%RESULTED%IN%A%NEED%FOR%CORNEAL%
TRANSPLANTS.%
! 49%YEAR%OLD%LADY%PRESENTS%FOR%HEMMOROID%SURGERY.%%DR%NOTICES%SOME%
WEBBING%ON%HER%FINGERS%AND%DECIDES%TO%SURGICALLY%SEPARATE%THEM.%
BLOOD%SUPPLY%THROUGH%WEBBING%FEED%ENDS%OF%THREE%FINGERS.%THREE%
FINGER%TIPS%BECAME%GANGRENOUS%&%WERE%AMPUTATED.%
Medical+errors+kill+enough+people+to+
ll+four+jumbo+jets+a+week.+
The+Wall+Street+Journal+September+21,+2012+^+WSJs+Gary+Rosen,+Author+Surgeon+Marty+Makary+
4%
2/11/14%
Four+Jumbo+Jets+a+Week%
THAT+IS+1,884+PEOPLE+
Risk+of+Dying+in+a+Hospital+
! The%chance%of%a%
hospital%error%is%about%
1+in+10+in%most%
hospitals%around%the%
world,%
! The%chance%of%dying%
from%that%error%is%about%
1+in+300.%%
1+in+3+Hundred+PaEents+
Liam+Donalson,+the+WHOs+(World+Health+OrganizaEon)++envoy+for+paEent+safety.+
5%
2/11/14%
Risk+of+Dying+in+an+Air+Crash+
Computer^generated+portrayal+of+collision+between+both+Boeing+747+
1+in+10+Million+Passengers+
1001crash.com+Lessons+learnt+for+aviaEon+safety+^+Liam+Donaldson,+the+WHOs+(World+Health+OrganizaEon)++envoy+for+paEent+safety%
6%
2/11/14%
How+to+Stop+Hospitals+From+Killing+Us%
How+to+Stop+Hospitals+From+Killing+Us+
The+Wall+Street+Journal+September+21,+2012+
WSJs+Gary+Rosen,+Author+Surgeon+Marty+Makary+
7%
2/11/14%
1.
2.
3.
4.
5.
%
Online%Dashboards%
Safety%Culture%
Cameras%
Open%Notes%
No%more%Gagging%
The%Wall%Street%Journal%September%21,%2012%
WSJs%Gary%Rosen,%Author%Surgeon%Marty%Makary%
1. Online+Dashboards+
That%includes:%
Its%rates%for%infec3on%
Readmission%(what%we%call%
"bounce%back")%
Surgical%complica3ons%
Annual%number%and%Types%
of%Surgery%performed%
Never%events%
Pa3ents%sa3sfac3on%scores%
8%
2/11/14%
2. Safety+Culture+
Speak%Up!!%this%sort%
of%cultural%factor%is%
so%important%to%
safety.%
3. Cameras+
The%notes%in%a%pa3ent's%
chart%are%onen%short,%
and%they%can't%capture%
a%procedure%the%way%a%
video%can.%
Wall+Street+Journal+September+21,+2012+
9%
2/11/14%
4. Open%Notes%
Harvard%doctorbresearchers%Jan%
Walker%and%Tom%Delbanco%are%using%
"open%notes"%at%Harvard%and%Beth%
Israel%Hospital%in%Boston,%%Geisinger%
Medical%Center%in%Pennsylvania,%has%
begun%giving%pa3ents%online%access%
to%their%doctors'%notes.%%
5. No+More+Gagging+
Increasingly,%pa3ents%checking%in%to%see%
doctors%are%being%asked%to%sign%a%gag%
order,%promising%never%to%say%anything%
nega3ve%about%their%physician%online%or%
elsewhere.%In%addi3on,%if%you%are%the%
vic3m%of%a%medical%mistake,%hospital%
lawyers%will%make%never%speaking%
publicly%about%your%injury%a%condi3on%
of%any%sePlement.%
The%Wall+Street+Journal+September+21,+2012+
10%
2/11/14%
Health+care+provider+liability+
Insurance+Policy+
HOSPITAL+PROFESSIONAL+LIABILITY+
GENERAL+LIABILITY++
11%
2/11/14%
Claims^made%coverages%apply%only%to%claims%arising%
from%events%which%occur%on%or%aner%the%retroac3ve%
date%stated%in%the%Declara3ons%and%reported%to%
Company%while%this%policy%is%in%force.%
%RetroacEve+Date+=+July+1,+2002+
%
%GENERAL+LIABILITY+
Occurrence+coverages%apply%only%to%claims%arising%
from%events%which%occur%while%this%policy%is%in%force.%
ABUSE+OR+MOLESTATION+EXCLUSION+
%
These%exclusions%apply%only%to%bodily%injury,%property%
damage,%adver3sing%injury%or%personal%injury%
arising+out+of+actual+or+alleged+sexual+abuse+or+sexual+
molestaEon.+
GICV%906%12%08%
12%
2/11/14%
Hospital+Professional+Liability+
We%will%pay%those%sums%that%the%insured%becomes%
legally%obligated%to%pay%as%damages%because%of%
injury%to%which%this%insurance%applies.%If%the%injury%is%
caused%by%a%"medical+incident"+that%takes%place%in%
the%"coverage+territory"+
13%
2/11/14%
WHO+IS+AN+INSURED+
Examples)
a) Named%Insured%%DIVISION%OWNED%HOSPITALS%
b) Partner,%Execu3ve%Ocer,%%%
c) Department%Head%(including%department%head%of%
medical%sta)%
d) Contract%Physicians%
e) Members%of%boards%or%commiPees%
%
Quick)Facts)
Coverage+
%Claims%Made%%
%Retroac3ve%Date:%July%1,%2002%
Limits+
%Each%Medical%Incident%%US$300,000%
%Policy%Period %%b%US$3,000,000%
14%
2/11/14%
DEFINITIONS+
Medical%Incident%means%any%act%or%omission:%
a. In%the%providing%of%or%failure%to%provide%
professional%health%care%services%to%your%
pa3ents,%including:%
1) The%providing%or%dispensing%of%food,%beverages,%
medica3ons%or%medical%supplies%or%appliances%in%
connec3on%with%such%services;%and%
2) The%handling%or%treatment%of%dead%bodies,%including%
autopsies,%organ%dona3on%or%other%procedures.%
DEFINITIONS+
Medical%incident%means%any%act%or%omission:%
b. Arising%out%of%the%service%by%any%person%as%a:%
1) Member%of%a%formal%accredita3on,%standards%review%
or%equivalent%professional%board%or%commiPee%of%the%
Named%Insured;%or%
2) Person%charged%with%execu3ng%the%direc3ves%of%such%
board%or%commiPee.%
15%
2/11/14%
STANDARD+EXCLUSIONS+
This%insurance%does%not%apply%to:%
Criminal+Acts+b%Injury%arising%out%of%a%criminal%act,%
including%but%not%limited%to%malicious%acts,%sexual%abuse%
or%molesta3on%or%fraud,%or%dishonesty%commiPed%by%or%at%
the%direc3on%of%the%insured.%
Contractual+Liability+b%Any%claim%for%damages%arising%out%
of%the%insureds%obliga3on%to%pay%damages%by%reason%of%
the%assump3on%of%liability%in%a%wriPen%or%oral%contract%or%
agreement.%This%exclusion%does%not%apply%to%liability%for%
damages%that%the%insured%would%have%in%the%absence%of%
the%contract%or%agreement.%
%This%insurance%does%not%apply%to:%
Breach%of%Contract%
Viola3on%Of%An%An3trust%Law%%
Workers%Compensa3on%And%Similar%Laws%
Employers'%Liability%
Aircran,%Auto%Or%Watercran.%(This%exclusion%does%not%
apply%to%loading%or%unloading%of%pa3ents%from%any%
ambulance)%
Fines%and%Penal3es%
%
16%
2/11/14%
COMMERCIAL+GENERAL+LIABILITY+CONDITIONS+
1. DuEes+In+The+Event+Of++A+Medical+Incident,+Claim+or+Suit+
c.
You%and%any%other%involved%insured%must:%
1) Immediately%send%us%copies%of%any%demands,%no3ces,%
summonses%or%legal%papers%received%in%connec3on%with%the%
claim%;%
2) Authorize%us%to%obtain%records%and%other%informa3on;%
3) Cooperate%with%us%in%the%inves3ga3on,%or%sePlement%or%defense%
against%the%suit%;%and%
4) Assist%us,%upon%our%request,%in%the%enforcement%of%any%right%
against%any%person%or%organiza3on%which%may%be%liable%to%the%
insured(s)%because%of%injury%to%which%this%insurance%may%also%
apply.%
d. No+insured(s)+will,+except+at+their+own+cost,+voluntarily+make+a+
payment,+assume+any+obligaEon,+or+incur+any+expense,+without+our+
consent.+
Commercial+General+Liability+
17%
2/11/14%
Commercial+General+Liability+
A%standard%insurance%policy%issued%to%business%
organiza3ons%to%protect%them%against%THIRD+PARTY+
liability%claims%for:%
%
Bodily%Injury,%%
Property%Damage,%%
Products,%and%Completed%Opera3ons,%%
Adver3sing%and%Personal%Injury,%and%Medical%Payments%%
GICV%925%08%11%Page%1%of%13%
GENERAL+LIABILITY+
Quick)Facts)
Coverage+
%Occurrence%%
Limits+
%Each%Occurrence%%US$1,000,000%
%Policy%Period %%b%None%
%
18%
2/11/14%
WHO+IS+AN+INSURED+
Examples)
Your%employees%and%Volunteers%while%ac3ng%
within%assigned%du3es.%
Any%of%your%members,%but%only%with%respect%to%
their%liability%for%your%ac3vi3es%that%are%
authorized%by%you%or%any%denomina3onally%
employed%person%to%whom%such%authority%has%
been%delegated.%
Any%trustee,%ocial,%member%of%the%board%of%
governors%or%clergyman%but%only%with%respect%to%
their%du3es%as%such.%
DEFINITIONS+
Bodily%Injury%b%%bodily%harm,%sickness,%or%disease,%
including%resul3ng%death.%
Property%Damage%b%physical%injury%to%tangible%
property.%
Products,%and%Completed%Opera3onsb%includes%all%
bodily%injury%and%property%damage%that%arises%out%of%
your%products%if%the%bodily%injury%or%property%
damage%occurs%aner%you%have%relinquished%possession%
of%those%products.%
%
%
19%
2/11/14%
DEFINITIONS+CONTINUED+
Adver3sing%and%Personal%Injury%%liability%arising%
out%of%the%insured's%adver3sing%of%its%goods%or%services:%
libel,%slander,%invasion%of%privacy,%copyright%
infringement,%and%misappropria3on%of%adver3sing%
ideas%
Medical%Payments%b%We%will%make%these%payments%regardless%of%fault.%
These%payments%will%not%exceed%the%applicable%limit%of%insurance.%We%will%pay%
reasonable%expenses%for:%
1) First%aid%at%the%3me%of%an%accident;%
2) Necessary%medical,%surgical,%xbray%and%dental%services,%including%
prosthe3c%devices;%and%
3) Necessary%ambulance,%hospital,%professional%nursing%and%funeral%
services.%
Expected%or%Intended%Injury%
Contractual%Liability%
Worker%Compensa3on%and%Similar%Laws%
Employer%Liability%
Pollu3on%(unless%is%Sudden,%Unintended%and%
Unexpected)%
Aircran,%Auto%or%Watercran%
Mobile%Equipment%
War%
20%
2/11/14%
Damage%to%Property%you%own,%rent,%or%occupy%
Damage%to%your%Product%
Damage%to%your%Work%
Damage%to%Impaired%Property%or%Property%Not%Physically%Injured%
Recall%of%Products,%Work%or%Impaired%Property%
Asbestos%
Firearms%
Airport%or%Airstrip%
Professional%Services%
Lead%Paint%
Silica%or%SilicabRelated%Dust%
COMMERCIAL+GENERAL+LIABILITY+CONDITIONS+
DuEes+In+The+Event+Of+Occurrence,+Claim+or+Suit+
You%and%any%other%involved%insured%must:%
1) Immediately%send%us%copies%of%any%demands,%no3ces,%summonses%
or%legal%papers%received%in%connec3on%with%the%claim%or%suit;%
2) Authorize%us%to%obtain%records%and%other%informa3on;%
3) Cooperate%with%us%in%the%inves3ga3on,%sePlement%or%defense%of%
the%claim%or%suit;%and%
4) Assist%us,%upon%our%request,%in%the%enforcement%of%any%right%against%
any%person%or%organiza3on%which%may%be%liable%to%the%insured(s)%
because%of%injury%or%damage%to%which%this%policy%may%also%apply.%
%
No+insured(s)+will,+except+at+their+own+cost,+voluntarily+make+a+payment,+
assume+any+obligaEon,+or+incur+any+expense,+other+than+for+rst+aid,+
without+our+consent.+
21%
2/11/14%
How+to+File+a+Claim+
+
E^mail:+%CLAIMS@ADVENTISTRISK.ORG%%
%
Fax:+(301)%680b6878%
%
Mail:+
Adven3st%Risk%Management%
APen3on:%Claims%&%Legal%Services%Department%
12501%Old%Columbia%Pike%
Silver%Spring,%MD%20904b6600%
22%
2/11/14%
THIS%POWER%POINT%PRESENTATION%AND%ANY%MATERIALS%DISTRIBUTED%ARE%FACT%BASED%GENERAL%INFORMATION%
AND% SHOULD% NOT,% UNDER% ANY% CIRCUMSTANCES,% BE% CONSIDERED% SPECIFIC% LEGAL% ADVICE% REGARDING% A%
PARTICULAR%MATTER%OR%SUBJECT.%PLEASE%CONSULT%YOUR%LOCAL%ATTORNEY%OR%RISK%MANAGER%IF%YOU%WOULD%
LIKE%TO%DISCUSS%HOW%A%LOCAL%JURISDICTION%DEALS%WITH%ANY%SPECIFIC%CIRCUMSTANCES%YOU%MAY%BE%FACING.%
23%

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